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Addiction and Opiates

Addiction and Opiates

Addiction and Opiates CHAPTER 1 METHOD AND PROBLEM several years was a further insurance against deception. On the whole, once friendly contact is made, drug users are probably above average in cooperativeness, because many of them believe that they ought to be studied and better understood. The data which they provided me were found to be quite' consistent with the material that the literature on opiate addiction offers. This study might be criticized on the grounds that the addicts who were interviewed did not constitute a representative sampling of American drug users. Indeed, no effort whatever was made to secure a sample that was representative in a statistical sense because it was not the purpose of the study to make a statistical description of the variable attributes and characteristics of American addicts. The purpose was rather to try. to find a plausible general theory of addiction, that is, to describe the nature of the experience from which the user's craving for the drug is derived. The investigation of any subject necessarily proceeds on the basis of assumptions that cannot themselves be established as valid in the research in question. One such assumption which underlies the present study is that the scientist who studies social or other phenomena should, whenever possible, seek to formulate generalizations that apply to all of the instances of the problem with which be is concerned, rather than to most or some of them only. In other words, it is assumed that genuinely scientific causal propositions should be stated as universals. This does not imply a belief in absolute truth as is sometimes erroneously assumed, since it is anticipated that all such generalizations will be accepted provisionally only, as long as no contradictory evidence is available or no better theory is at hand. This assumption implies the belief that it is possible for the social scientist as well as for the natural scientist to state theories in such a form as to suggest crucial instances testing the theory and to permit the search for negative cases. It is assumed, in other words, that the exceptional instance is the growing point of science and that cumulative growth and progressive development of theory is obtained by formulating generalizations in such a way that negative cases force us either to reject or to revise them.(3) The methodological orientation of this study is deterministic rather than statistical. Applied to the study of narcotics addiction, each of these orientations has its own characteristic goals, methodological assumptions, and analytical procedures, and neither can be judged by the standards of the other. Failure to distinguish between them leads to intellectual confusion. The assumption made at the outset of this investigation-that the craving for drugs is generated in one identifiable, unitary type of experience-is deterministic in nature. The research problem it poses is that of identifying or discovering and describing such an experience and indicating bow and why the patterns of behavior called addiction follow from it. It is incongruous and illogical to consider such an experience as a "variable" to be handled by' statistical methods. This is because an "experience" is a complex interactional process- involving many elements or variables in a series of happenings or events. Moreover, if one insists on speaking of such a sequential process as a variable, it must be noted that it is not at band at the outset of the study since it has not yet been identified and described. From the deterministic viewpoint the whole trick consists of finding or identifying it. To suggest that this identification be made by statistical methods presupposes the knowledge that is being sought. It is more appropriate to consider the statistical approach to drug addiction within its own frame of reference as a technique of describing average behavior of aggregates of individuals or of making mass comparisons between groups of addicts and non addicts. Such comparisons and descriptions have dealt with a wide variety of attributes, characteristics, and background factors such as those of age, sex, social status, place of residence, occupation, and personality attributes. These investigations have their own particular kind of merit or significance. They may, for example, illuminate such matters as why addiction rates are higher in one segment of the population than in another; they may indicate that certain identifiable personality traits increase the probability of addiction-, they may suggest that public policies of dealing with addiction have important consequences on the prevalence of addiction and on variations in its incidence. Such studies are often of great practical importance. They may also be of theoretical significance at their own level-that of broad "social system" or societal analysis. They may suggest ideas to the determinist, and their findings must be taken into account, but they do not have a direct bearing on the determinist's search for the causal process or processes that always and everywhere generate addiction. The difference between these two types of enterprise is analogous to that between explaining malaria and explaining malaria rates, or crime and crime rates. From a deterministic standpoint, conclusions derived from statistical comparisons of addicts with non-addicts which assert as a "theory" that a given attribute is significantly more frequent among drug users than in the general population are file:///I|/drugtext/local/library/books/adopiates/chapter1.htm[24-8-2010 14:23:31]

Addiction and Opiates CHAPTER 1 METHOD AND PROBLEM simply not theories at all. The attempt to identify causal relationships and the assumption that such relationships can be found dictate that all relevant and available evidence, including the results of statistical studies, be taken into consideration. In particular, this methodological stance requires intensive, exhaustive probing of individual cases and comparison of certain crucial types of cases. Thus, when it was noted that some non addicts receive drugs regularly for long periods of time in hospitals without becoming addicts, I was compelled to compare them with addicts in order to isolate and describe the causal processes which were present in the cases of addiction and absent among the non-addicted hospital patients. No tabulations were necessary in making this comparison because it was assumed that the essential causal process of addiction would be found in all cases of addiction and that it would not be found in any case of non-addiction. The addicts who were interviewed contributed very unequally to the final theoretical formulation. As already indicated, some were not seen often enough. Others were inarticulate or lacked the necessary intelligence or interest to provide coherent accounts of their initial experiences with drugs. Many who were interviewed in the later stages of the investigation provided data of relatively little theoretical import because the information they gave followed a pattern made familiar by earlier cases without adding new elements or posing new problems. Only a relatively small proportion of the addicts interviewed, consisting mainly of intelligent, articulate, experienced, and self-observant users, made important contributions to the formulation of the theory. Some of these crucial cases forced the abandonment of provisional hypotheses that had been entertained up to the time they were encountered. Others seemed to bring out in a striking and obvious way the nature of the process in which addiction is established. This was because they were departures from the standard and familiar pattern, presenting combinations of circumstances and conditions of the type which one would wish to have in an experimental test of the theory. Aft& familiarity with the general characteristics of the addict's behavior bad been acquired from the initial conversations with users, the subsequent progress of the study seemed to depend upon the analysis of a series of crucial cases which led to successive revisions of the guiding ideas of the study and to broader perceptions of the logical implications and ramifications of these ideas. As the analysis progressed the various aspects of addiction behavior, which had at first seemed to be isolated, discrete bits of information or even paradoxical in nature, fell into place to form integral parts of what eventually seemed to me to be a consistent and logical whole. The literature of addiction is highly repetitive, sometimes unreliable, and often based on misinformation. In the later stages of the study, however, it probably became my most important source of data. The interviews with addicts and observations of them provided standards for judging the literature and enabled me to understand the sources of error and distortion. The evidence available in books and articles served the vital function of providing a broad, world-wide perspective, limited by neither space nor time. Without such a perspective it would have been easy to fall into the error of taking the part for the whole, that is, of assuming that a particular manifestation or form of addiction limited to a particular time or place was the prototype of all addiction. Thus, no general theory of opiate addiction can be based on effects which are produced only when heroin is injected intravenously, as it usually is at present in this country, since opiate addiction existed many thousands of years before heroin or the intravenous method of injection were known. The strategy of the research was one of focusing on a strictly limited and specific problem, analyzing it as exhaustively as possible, and leaving out of consideration a great many other matters that might be of interest and significance in connection with other types of theories or interests. This study, it will be observed, is not a study in motivation and therefore does not propose an explanation of addiction in terms of the motives or purposes that people have for trying drugs. It began as a search for the experience or process in which addiction is invariably generated, without any prejudgments concerning the motivation question. As it progressed it seemed evident that no general theory of addiction in terms of motives was possible. This was because: (1) hospital patients sometimes become addicted when doctors prescribe drugs for them without the patient ever voluntarily administering the drug to himself; (2) motives or verbal rationalizations of drug users vary widely from person to person, from culture to culture, and from time to time, and they are often contradictory and inconsistent; and (3) while initial use of the drug is often but not always voluntary, non addicts are rarely motivated to become addicts, but are rather trapped by the drug, often unwittingly or against their wills. As will be indicated later, the initial effects of drugs upon the beginner are not at all comparable to the effects of the same drug upon the habitual user, and, by the same token, explaining the first trial is a separate and distinct problem from that of accounting for addiction. file:///I|/drugtext/local/library/books/adopiates/chapter1.htm[24-8-2010 14:23:31]

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